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The Pennine Acute Hospitals NHS Trust Summary Operational Plan 2016/17

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Introduction

Pennine Acute Hospitals NHS Trust provides a range of acute, community and integrated

health and social care services to 820,000 people in north east Greater Manchester. The

contents of this Summary Operational Plan for 2016/17 are consistent with delivery of the

overall Greater Manchester Strategic (Sustainability and Transformation) Plan which

includes initiatives such as Healthier Together and the Manchester Single Service Hospital

review. The Plan is also consistent with the Locality plans of its four main commissioners –

North Manchester, Bury, Oldham and Rochdale Clinical Commissioning Groups (CCGs).

Operational Plan 2016/17

Our Operational Plan for 2016/17 covers a range of quality, workforce and financial issues

that the Trust will be responding on in order to support delivery of the Trusts Corporate

Priority objectives for 2016/17 which were agreed in May 2016, and to address the findings

of the recent Care Quality Commission (CQC) inspection and the Salford Royal Hospitals

NHS Foundation Trust diagnostic review of August 2016. The findings of the latter two items

require the delivery of a number of key actions that are sympathetic to the delivery of the

Trusts Corporate Priorities. The Operational Plan for 2016/17 will be delivered by the Trust

with the support of the senior management of Salford Royal Hospitals NHS Foundation

Trust.

Corporate Priorities

The Trusts new Corporate Priority objectives and targets for 2016/17 are illustrated in the

table below.

Corporate Priority

2016/17 Target

Pursue Quality Improvement to assure safe, reliable and compassionate care

Save lives

Assure a year on year reduction in the standardised mortality rate to within the top 10% of Acute Trusts nationally

Meet CQC requirements

Deliver improvements within time scales

Reduce harm

Assure safety thermometer target so that at least 95% of patients receive harm free care

Improve patient experience

Demonstrate improvements so that patients “would recommend as a place for treatment” on NHS patient

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Corporate Priority

2016/17 Target

survey

Deliver financial plan to assure sustainability

Drive efficiency & productivity to deliver substantial financial improvement including cost improvements of at least £25.8m Reduce spend on agency staff

Support our staff to deliver high performance and improvement

Improve staff engagement score

Use NHS staff survey staff engagement score and Friends and Family test to demonstrate improvement, so that the Trust is recommended as a place to work

Improve staff contribution to goals & values

Implement the new staff contribution assessment framework to ensure that staff receive an effective and quality appraisal

Reduce staff sickness absence to 4.6%

Implement Healthy, Happy, Here workforce plan

Improve care and services through integration and collaboration

Support development of Local Care Organisations in Oldham, Bury, Rochdale and Manchester

Describe the Trust’s contribution to improvements in locality plans.

Agree at least one key aim per locality with stakeholders

Progress Single Hospital Service in Manchester

Develop and implement an action plan for North Manchester General Hospital to form part of a Single Hospital Service for the City of Manchester and assure safe and effective services are supported at Oldham, Bury and Rochdale

Improve the Urgent Care Service at North Manchester in line with CQC and NHS Improvement requirements

Implement urgent care improvement

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Corporate Priority

2016/17 Target

plan

Deliver on A&E 4 hour standard in line with stretch trajectory

Assure developments of high acuity services at The Royal Oldham as part of Healthier Together

Implement Healthier Together standards for general surgery by April 2017

Improve services through ‘standardisation at scale’ in association with Salford Royal NHS Foundation Trust

Demonstrate compliance with mandatory standards

Infections

C.Diff = <55 cases

MRSA = 0 cases

Set targets for each site to achieve above

Achieve Access standards:

A&E 4 hour standard

Referral To Treatment (RTT) 18 week standard

Cancer 62 day standard

Diagnostics 6 week standard

Deliver endoscopy improvement plan

CQC Inspection

Following an inspection by the CQC during February-March 2016, the Trust’s services were

given an overall rating of inadequate. The table below illustrates the break down by site and

service.

Service area

North

Manchester

Royal Oldham Fairfield

General

Rochdale

Infirmary

Urgent &

Emergency Inadequate Requires

Improvement Requires

Improvement Requires

Improvement

Medical Care Inadequate Requires

Improvement Requires

Improvement Good

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Service area

North

Manchester

Royal Oldham Fairfield

General

Rochdale

Infirmary

Surgery Requires

Improvement Requires

Improvement Requires

Improvement Good

Critical Care Good Inadequate Requires

Improvement

Maternity &

Gynaecology Inadequate Inadequate

Services for

Children & Young

People

Inadequate Inadequate

End of life Care Good Requires

Improvement Requires

Improvement

Outpatients &

Diagnostic Imaging Good Good Good Good

Overall Inadequate Inadequate Requires

Improvement Good

Community Services for CYP, Adults and End of Life Safe Effective Caring Responsive Well Led

Good Good Good/Outstanding Good Good

Whilst the Trust’s Rochdale Infirmary, Outpatients and Diagnostic Imaging, were rated as

good, and Community services were given good ratings and good/outstanding for the Caring

domain, the inspection report highlighted a number of serious concerns about other, mainly

hospital, services. The report included 77 “must do“ actions and 144 “should do” actions,

relating to our most vulnerable and at risks patients, including;

Patients attending in need of emergency or critical care

Children, babies and young people

Patients that are at end of life

Adults who lack mental capacity

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Salford Royal Hospitals Diagnostic review

In April 2016, following the appointment of an interim Chief Executive Officer and Chair from

Salford Royal Hospitals NHS Foundation Trust, an internal diagnostic commenced at their

request in parallel to the CQC Inspection. Its findings concurred with those of the CQC

inspection. The diagnostic highlighted a number of critical risks to patient care and safety, in

particular variations in care between sites and staff survey responses though which our Staff

raised concerns about the Trusts standards of care, and the Trust as a place to work.

Improving our Services

Building on work that had already commenced within the Trust’s A&E, Maternity and

Paediatrics services, during 2016/17 the Trust will be working closely with colleagues from

Salford Royal NHS FT, our four local Commissioners, local Councils and NHS Provider

colleagues, as well as our regional partner agencies across Greater Manchester, through an

Improvement Board, to look at ways we can improve the quality of services that we deliver,

strengthen medical and nurse staffing, strengthen our models of care, support staff on the

frontline particularly in respect of our most pressured services. We will reassure our patients

and their families through regular communications on progress as we improve our services.

This will be done through a series of improvement projects covering the following themes;

Fragile Services, Safety, Operations and Performance, Risks and Governance, Workforce

and Leadership. The initial phase during 2016/17 will be to achieve stabilisation, with

transformation taking place during 2017/18.

Assurance will be given through the establishment of a new Trust Board led by Salford Royal

Hospitals, with all projects monitored by new Board assurance committees to ensure

sustainability. The improvement projects will be based on 90 day planning cycles and will be

managed and tracked by the Integrated Management Office and the Trust Care Board,

reporting by exception to the Greater Manchester Improvement Board.

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Themes Improvement Projects

Measurement Deliverables during 2016/17

(stabilisation)

Deliverables during 2017/18

(transformation) Fragile Services

Urgent Care

Maternity

Paediatrics

Critical care

Emergency Department

quality standards, safe

staffing

Safe staffing, harm profile,

Serious Incidents

Safe staffing, essential

training, transfers out of

Trust

Safe staffing and national

standards

Delivery on stabilisation

models as per Greater

Manchester Improvement

Board

Clinically safe and

sustainable services

Safety

A consistent set of high standards for every ward

Large scale quality improvement collaborative focussing on the critically unwell and the prevention and control of infection

End of life and bereavement care

Safe medicines management

Nursing Assessment and

Accreditation System

Scorecards

Quality Improvement

dashboard measures,

harms and mortality

All wards assessed against

essential care standards by

December 2016

Collaborative launched

January 2017 with early

improvement

Baseline medicines

management assessment

Plans in place to drive

improvement across all

clinical wards/departments

assessed

Reduction in harms and

mortality

Safe and reliable medicines

management

Clear pathways for

resuscitation and enhanced

experience for patients and

families at End Of Life

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Themes Improvement Projects

Measurement Deliverables during 2016/17

(stabilisation)

Deliverables during 2017/18

(transformation) Risk and Governance

Implement new risk and governance arrangements across the Trust

Ensuring all safeguarding systems to protect patients are consistently in place

Incident Reporting, Risk

Registers

New Datix system procured

Risk training for all clinical

staff

New Board Assurance

Framework

New Risk and Governance

Framework

Baseline review of

Safeguarding including

Deprivation of Liberty

Safeguards and Mental

Capacity Act training

New Datix system in place

Improved culture of

reporting and learning from

incidents

Board to ward assurance on

key risks to delivery of

objectives

Assurance on safeguarding

systems and processes

Operations and Performance

Data quality and patient pathway management

Improve patient flow systems

Data Quality Reports,

compliance with waiting

times standards

Delayed discharges,

Outliers, Transfers of care

Full Patient Admission

System cleanse and robust

Patient Tracking List tracking

and RTT management

Data Quality assurance

Systems and process for

managing flow in place

Delivery on waiting times

standards

Reduction in outliers,

delayed discharges ,

transfers of care and mixed

sex breaches

Workforce

Safe staffing

New recruitment model

Developing our staff and improving engagement

Safer Staffing Dashboard,

Vacancy rates, Sickness

absence, Time to recruit,

Learning & Development

dashboard

All staffing assessed across

clinical areas

New recruitment model

outlined and in place

Training needs analysis and

plan outlined

Safe and sustainable

staffing models for nursing

and medical staff

Reduction in vacancies and

locum/agency staff

Personal Development

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Themes Improvement Projects

Measurement Deliverables during 2016/17

(stabilisation)

Deliverables during 2017/18

(transformation) Workforce

Reviews, mandatory training

and other Training needs

analysis meeting

requirements and standards

Leadership

Consistent leadership and executive team

Strengthen local site leadership (Oldham, Bury, Rochdale, Manchester)

Clinical leadership development

Management contract in

place

New leaders and

accountability framework

in place

Clinical leadership

development programme

procured

Site leadership teams

and accountability to

Group in place

Clinical leaders driving

improvement

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Finance

As well as delivering the required improvement to its services as described above, the Trust has a challenging financial target, with an underlying deficit position. The Trust’s 2016/17 financial plan has been based on the Trust delivering on its 2015/16 “stretch target” deficit of £19.9m, the achievement of which was dependent on taking a number of significant non-recurrent measures which are unavailable to the Trust in 2016/17. The original submitted plan was for a deficit of £39.7m however, following agreement with NHS Improvement, the Trust has agreed a control total of a £15.2m deficit which, if achieved, secures Sustainability and Transformation Funding of £20.5m The Trust planned bottom line deficit of £15.2 assumes (with varying degrees of risk):

All targets are met in order to receive £20.5m from the Sustainability and Transformation Fund (STF).

£7.5m is received from the CCG’s 1% contingency reserve

Agency spend is reduced to £29.9m in year, compared to a full year spend of £38.6m in 2015/16

The Cost Improvement Target of £25.8m is delivered

£3.1m is secured from the Greater Manchester Transformation Fund to support a robust Transformation programme for the Trust.

Activity

The Trusts operational services have plans in place to deliver its activity plans and targets

for 2016/17, working closely with other stakeholders as required to address areas where

there are pressures.

The activity plan takes into account the impact of Locality Plans and CCG commissioning

intentions based on a high level assessment of anticipated population growth and deflection

schemes which will be refined through on-going contract negotiations and discussions for

2016/17.

Key areas that the Trust’s activity plan is focused on are;

Achievement of the trajectories agreed with NHS Improvement and CCGs to imprve

performance against key access targets;

o Achieving Accident and Emergency waiting times

o Consistently meeting its referral to treatment (RTT) incomplete target and

ensuring that the number of “open pathways” remain within tolerance

o Meeting its cancer performance targets by;

Maintaining its current two week wait performance

Continuing successful achievement of 31 day first treatment and 31

day subsequent treatment of the 62 day General Practitioner referral

standard

Improving performance on the 62 day consultant upgrade standard

Working with other providers across Greater Manchester to jointly improve the

delivery of Gastro-intestinal and Urological Cancers

Improving its diagnostic service waiting times

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Sustainability and Transformation Plans

Our Operational Plan for 2016/17 is linked to the Greater Manchester Health and Social

Care Devolution (GM Devolution) programme, and the Trust has aligned its plans with those

of its North East sector partners (the Trusts Clinical Service Transformation Plan is fully

referenced in the Locality Plans for Bury, Oldham and Rochdale) and in turn to the wider

ambitions of GM Devolution. In pursuit of this a Memorandum of Understanding on Health

and Social Care devolution was signed in February 2015: NHS England plus the 10 Greater

Manchester Councils, 12 Clinical Commissioning Groups and 15 NHS and Foundation

Trusts (including Pennine Acute Hospitals).

A core element of service development in Greater Manchester is the establishment of single

service models for key aspects of healthcare, with Healthier Together leading the way in this

regard: the Royal Oldham identified as a specialist hospital, supported by North Manchester

and Fairfield General Hospitals as its local counterparts. Rochdale Infirmary remains out of

scope but fully engaged. A draft implementation plan is being progressed.

The Trust is a key partner in the delivery of the locality plans of the CCGs we serve, for

example: the Single Hospital Service for the locality of Manchester; Local Care

Organisations for Manchester; and the Accountable Care Management Organisation in

Oldham, together with a range of other locality based initiatives.

The Manchester Locality Plan has as one of its three central pillars, the establishment of a

Single Hospital Service for the City of Manchester – the Trust is an active participant in this

work under which a Single Hospital Trust serving Manchester is envisaged. This entails the

merger of Central Manchester NHS FT and University Hospitals of South Manchester NHS

FT to form a new NHS FT (by April 2017), and, within the 18 months following that, the

transfer or the Trusts North Manchester services into the new Manchester organisation.

It is envisaged that the Trust’s remaining services in Bury, Rochdale and Oldham will form

part of a chain of Trusts linked to Salford Royal Hospital NHS Foundation Trust.

For further information about the Trust and its services, please visit the Trust website at

www.pat.nhs.uk

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